Hayward Animal Shelter Reading Program Participation and Waiver

Hayward Animal Shelter Reading Program Participation and Waiver

Please complete this form to participate in the Hayward Animal Shelter Reading Program. Review the waiver below and sign to provide consent.
Adult Participant Name
Child Participant Name
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
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Emergency contact name
Relationship to participant
Day Phone (Emergency Contact)
Please enter a valid phone number.Format: (000) 000-0000.
Evening Phone (Emergency Contact)
Please enter a valid phone number.Format: (000) 000-0000.
I understand that as part of the Hayward Animal Shelter Reading Program, I and my child/children will be interacting with Hayward Animal Shelter animals. I recognize that, while participating in the Hayward Animal Shelter Reading Program, a risk of injury exists, including but not limited to, personal physical harm and/or property damage. Animals, even in the best of circumstances, may be unpredictable and may bite or scratch. I understand that the animals involved in the Hayward Animal Shelter Reading Program are shelter animals and not trained or registered therapy animals.I (print name)blanks the parent or legal guardian of blank choose to permit them to participate in the Hayward Animal Shelter Reading Program. On behalf of myself, my heirs and executors, in consideration of any participation in the Reading Program at Hayward Animal Shelter, hereinafter, hereby release and hold harmless Hayward Animal Shelter and others connected with Hayward Animal Shelter from any and all claims damages and injuries which I or my child may suffer in connection with the Reading Program. I give my consent for Hayward Animal Shelter to use my child’s name, likeness, voice or biographical information and any photos, recordings, or video recordings taken or any other publicity including my child participating in the Reading Program at the Hayward Animal Shelter.
Signature of parent or legal guardian
Date

MonthDayYear
Date
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